Audit of quality of perioperative antimicrobial prophylaxis

Objective To assess the perioperative antibiotic prophylaxis (PAP) prescriptions in a general hospital, Diyarbakir, Turkey. Method An evaluative audit in a prospective cohort included into the study between February and June 2003. All clean and clean-contaminated elective surgical procedures in six surgical wards were recorded. Using the ATC-DDD system, density of antimicrobial use was calculated per procedure. Results Totally 331 of 391 (84.7%) study procedures received PAP. PAP was indicated in 45% of PAP non-received group and not indicated in 15.1% of received group. Only 18.4% of PAP lasted less than 24 h. The most common prescribed agents were the first generation cephalosporins (85.8%) and aminoglycosides (24.2%). Timing of the initial dose was inappropriate in 135 procedures (40.8%). Only in 44 procedures (13.3%) all steps of PAP were found justified and correct in PAP received group. The mean dosage number of PAP (±SD) for per operation was 8.7 ± 12.5. The density of antimicrobial use was calculated as 330.2 DDD/100-operation. The density of antimicrobial use per operation was 3.3 DDD. Conclusion The density of antimicrobial use in PAP is very high. To improve the appropriateness of PAP, measure of antibiotic use is urgently required.